Anorexia nervosa - Revision history

Rossdonaldson1: /* Disposition */

2023-02-01T22:35:38Z

Disposition

← Revisión anterior		Revisión del 22:35 1 feb 2023
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	*Inpatient management for:		*Inpatient management for:
	**Extremely low weight (<75% of expected body weight) or rapid weight loss		**Extremely low weight (<75% of expected body weight) or rapid weight loss
	**Hypotension (< 80/50)		**[[Hypotension]] (<80/50 mmHg)
	**Hypothermia (< 96 degrees F)		**[[Hypothermia]] (<96 degrees F)
	**Severe electrolyte imbalances		**Severe [[electrolyte imbalances]]
	**Cardiac disturbances		**Cardiac disturbances
	**Bradycardia < 50		**[[Bradycardia]] <50
	**Acute medical disorders		**Acute medical disorders
	**Severe or intractable purging		**Severe or intractable purging
	**Psychosis or a high risk of suicide		**Psychosis or a high risk of [[suicide]]

	==Also See==		==Also See==

Rossdonaldson1: /* Diagnostic Criteria */

2023-02-01T22:34:43Z

Diagnostic Criteria

← Revisión anterior		Revisión del 22:34 1 feb 2023
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	[[File:Anorexia case-1900-Nouvelle icononographie de la Salpetriere.jpg\|thumb\|Patient with anorexia nervosa.]]		[[File:Anorexia case-1900-Nouvelle icononographie de la Salpetriere.jpg\|thumb\|Patient with anorexia nervosa.]]
	===Diagnostic Criteria===		===Diagnostic Criteria===
	*A. Restriction of energy intake relative to requirements, leading to a significantly low body weight in the context of age, sex, developmental trajectory, and physical health. Significantly low weight is defined as a weight that is less than minimally normal or, for children and adolescents, less than that minimally expected. <ref>American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.</ref>		#Restriction of energy intake relative to requirements, leading to a significantly low body weight in the context of age, sex, developmental trajectory, and physical health. Significantly low weight is defined as a weight that is less than minimally normal or, for children and adolescents, less than that minimally expected. <ref>American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.</ref>
	*B. Intense fear of gaining weight or of becoming fat, or persistent behavior that interferes with weight gain, even though at a significantly low weight.		#Intense fear of gaining weight or of becoming fat, or persistent behavior that interferes with weight gain, even though at a significantly low weight.
	*C. Disturbance in the way in which one’s body weight or shape is experienced, undue influence of body weight or shape on self-evaluation, or persistent lack of recognition of the seriousness of the current low body weight.		#Disturbance in the way in which one’s body weight or shape is experienced, undue influence of body weight or shape on self-evaluation, or persistent lack of recognition of the seriousness of the current low body weight.

	===Symptoms===		===Symptoms===

Rossdonaldson1: /* Clinical Features */

2023-02-01T22:34:24Z

Clinical Features

← Revisión anterior		Revisión del 22:34 1 feb 2023
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	==Clinical Features==		==Clinical Features==
			[[File:Anorexia case-1900-Nouvelle icononographie de la Salpetriere.jpg\|thumb\|Patient with anorexia nervosa.]]
	===Diagnostic Criteria===		===Diagnostic Criteria===
	*A. Restriction of energy intake relative to requirements, leading to a significantly low body weight in the context of age, sex, developmental trajectory, and physical health. Significantly low weight is defined as a weight that is less than minimally normal or, for children and adolescents, less than that minimally expected. <ref>American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.</ref>		*A. Restriction of energy intake relative to requirements, leading to a significantly low body weight in the context of age, sex, developmental trajectory, and physical health. Significantly low weight is defined as a weight that is less than minimally normal or, for children and adolescents, less than that minimally expected. <ref>American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.</ref>

Elcatracho: /* Management */

2021-02-09T15:33:32Z

Management

← Revisión anterior		Revisión del 15:33 9 feb 2021
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	***Osteoporosis due to HPA dysfunction		***Osteoporosis due to HPA dysfunction
	***Risk of fracture with minimal or no trauma		***Risk of fracture with minimal or no trauma
			*Must avoid use of [[bupropion]] as it may lead to seizures in patients with eating disorders

	==Disposition==		==Disposition==

ClaireLewis at 16:57, 14 September 2019

2019-09-14T16:57:29Z

← Revisión anterior		Revisión del 16:57 14 sep 2019
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	==Background==		==Background==
	*Associated with body image disturbance		*Associated with body image disturbance
	*~~Adolescent~~ girls		*Usually seen in adolescent girls
			**3rd most common chronic condition in adolescent girls
	**Life long risk		**Life long risk
	*Body image is predominate measure of self worth		*Body image is predominate measure of self worth
	*Mortality 6-20%		*Mortality 6-20%, highest of any psychiatric disorder

	==Clinical Features==		==Clinical Features==
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	*Loss of subcutaneous fat		*Loss of subcutaneous fat
	*Breast and vaginal atrophy		*Breast and vaginal atrophy

			===Associated conditions===

	==Differential Diagnosis==		==Differential Diagnosis==
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	*Major depressive disorder		*Major depressive disorder
	*[[Schizophrenia]]		*[[Schizophrenia]]
	*Substance ~~use disorders~~		*[[Substance abuse]]
	*Social anxiety disorder		*Social [[anxiety]] disorder
	*Obsessive-compulsive disorder		*Obsessive-compulsive disorder
	*Body dysmorphic disorder
	*[[Bulimia nervosa]]		*[[Bulimia nervosa]]
	*Avoidant/restrictive food intake disorder

	==Evaluation==		==Evaluation==
	*Exclude: Inflammatory bowel disease, hyperthyroidism, chronic infection, diabetes mellitus, and Addison’s disease<ref>John F. Bober, Scott E. Moser: Rakel: Textbook of Family Medicine, 8th ed., Saunders, 2011 (Ch)24: p452</ref>		*Exclude: Inflammatory bowel disease, hyperthyroidism, chronic infection, diabetes mellitus, and Addison’s disease<ref>John F. Bober, Scott E. Moser: Rakel: Textbook of Family Medicine, 8th ed., Saunders, 2011 (Ch)24: p452</ref>
	*CBC		*CBC
			**[[Anemia]], [[leukopenia]] in severe disease
	*Chem 10		*Chem 10
			**[[Hypoglycemia]], [[hypophosphatemia]] in severe disease
	*[[ECG]]		*[[ECG]]

	==Management==		==Management==
	*Inpatient management		*Treat medical complications<ref>https://pedemmorsels.com/eating-disorders/</ref>
			**Cardiovascular
			***[[Bradycardia]] due to increased vagal tone
			***Other serious [[dysrhythmias]]
			***Decreased cardiac muscle from malnutrition --> cardiac dysfunction, [[mitral valve prolapse]]
			***Caution with rate of [[IVF]] (risk of [[pulmonary edema]])
			**Fluid/Electrolytes
			***Serious [[electrolyte abnormalities]] can occur
			****[[Hypophosphatemia]] can impair cardiac and diaphragmatic muscle contractions--> [[respiratory arrest\|respiratory]]/[[cardiac arrest]]
			****[[Hypomagnesemia]], [[hypokalemia]] and alterations with refeeding can cause [[arrhythmia]]
			***[[Refeeding syndrome]] risk
			***Even 1L of d5 NS could harm patient subsisting on <400kcal daily
			**Gastrointestinal
			***Delayed gastric/colonic emptying--> [[gastroparesis]], distension, [[GERD]], [[constipation]], [[SMA syndrome]]
			**MSK
			***Osteoporosis due to HPA dysfunction
			***Risk of fracture with minimal or no trauma

			==Disposition==
			*Inpatient management for:
	**Extremely low weight (<75% of expected body weight) or rapid weight loss		**Extremely low weight (<75% of expected body weight) or rapid weight loss
	**Hypotension (< 80/50)		**Hypotension (< 80/50)
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	**Severe or intractable purging		**Severe or intractable purging
	**Psychosis or a high risk of suicide		**Psychosis or a high risk of suicide

	~~==Disposition==~~

	==Also See==		==Also See==

Kxl328: /* Management */

2018-10-09T05:16:25Z

Management

← Revisión anterior		Revisión del 05:16 9 oct 2018
Línea 49:		Línea 49:

	==Management==		==Management==
	*~~inpatient~~ management		*Inpatient management
	**Extremely low weight (<75% of expected body weight) or rapid weight loss		**Extremely low weight (<75% of expected body weight) or rapid weight loss
			**Hypotension (< 80/50)
			**Hypothermia (< 96 degrees F)
	**Severe electrolyte imbalances		**Severe electrolyte imbalances
	**Cardiac disturbances		**Cardiac disturbances
			**Bradycardia < 50
	**Acute medical disorders		**Acute medical disorders
	**Severe or intractable purging		**Severe or intractable purging

Rossdonaldson1: /* Management */

2016-11-13T19:40:06Z

Management

← Revisión anterior		Revisión del 19:40 13 nov 2016
Línea 56:		Línea 56:
	**Severe or intractable purging		**Severe or intractable purging
	**Psychosis or a high risk of suicide		**Psychosis or a high risk of suicide

			==Disposition==

	==Also See==		==Also See==

Humanguy: Removed general psych differential, created new differential diagnosis list

2016-11-11T09:03:16Z

Removed general psych differential, created new differential diagnosis list

← Revisión anterior		Revisión del 09:03 11 nov 2016
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	==Differential Diagnosis==		==Differential Diagnosis==
	~~{{Psych DDX}}~~		*Gastrointestinal disease
			*[[Hyperthyroidism]]
			*Occult malignancies
			*[[AIDS]]
			*Major depressive disorder
			*[[Schizophrenia]]
			*Substance use disorders
			*Social anxiety disorder
			*Obsessive-compulsive disorder
			*Body dysmorphic disorder
			*[[Bulimia nervosa]]
			*Avoidant/restrictive food intake disorder

	==Evaluation==		==Evaluation==

Humanguy: Added diagnostic criteria

2016-11-11T08:41:43Z

Added diagnostic criteria

← Revisión anterior		Revisión del 08:41 11 nov 2016
Línea 7:		Línea 7:

	==Clinical Features==		==Clinical Features==
			===Diagnostic Criteria===
			*A. Restriction of energy intake relative to requirements, leading to a significantly low body weight in the context of age, sex, developmental trajectory, and physical health. Significantly low weight is defined as a weight that is less than minimally normal or, for children and adolescents, less than that minimally expected. <ref>American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.</ref>
			*B. Intense fear of gaining weight or of becoming fat, or persistent behavior that interferes with weight gain, even though at a significantly low weight.
			*C. Disturbance in the way in which one’s body weight or shape is experienced, undue influence of body weight or shape on self-evaluation, or persistent lack of recognition of the seriousness of the current low body weight.

	===Symptoms===		===Symptoms===
	*[[Constipation]]		*[[Constipation]]

Rossdonaldson1: Text replacement - "ECG" to "ECG"

2016-09-09T13:35:35Z

Text replacement - "*ECG" to "*ECG"

← Revisión anterior		Revisión del 13:35 9 sep 2016
Línea 30:		Línea 30:
	*CBC		*CBC
	*Chem 10		*Chem 10
	*ECG		*[[ECG]]

	==Management==		==Management==

Anorexia nervosa - Revision history

Rossdonaldson1: /* Disposition */

Rossdonaldson1: /* Diagnostic Criteria */

Rossdonaldson1: /* Clinical Features */

Elcatracho: /* Management */

ClaireLewis at 16:57, 14 September 2019

Kxl328: /* Management */

Rossdonaldson1: /* Management */

Humanguy: Removed general psych differential, created new differential diagnosis list

Humanguy: Added diagnostic criteria

Rossdonaldson1: Text replacement - "*ECG" to "*ECG"

Rossdonaldson1: Text replacement - "ECG" to "ECG"